Neurological

Erenumab self-injections for idiopathic intracranial hypertensive headache

Erenumab successfully treated symptoms of idiopathic headache with intracranial hypertension (IIH), according to the study results published in Headache.

Headaches largely affect disability in IIH. This study sought to evaluate the effectiveness of erenumab in treating headache in patients with IIH whose disc edema has resolved.

Study researchers at the University of Birmingham in the UK conducted a prospective study recruiting women (N = 55) with IIH in ocular remission who suffered from chronic migraine-like headaches (³15 / month) between October 2018 and August 2019. administered 70 mg 4-weekly injections of erenumab. Every 3 months, the study researchers checked the patients’ headache diaries, IIH symptoms, and the headache impact test (HIT-6). They also reviewed the patient’s short-form health survey at baseline, 6 months, and 12 months.

Participants had an average age of 35.3 years (standard deviation) [SD], 9) years, had an average of 1.7 (SD, 2.5) years headache after their disc edema resolved, and had 29.0 (SD, 2.3) mean headache days per month. The mean headache severity was high (6 out of 10; SD, 1.3) and affected daily life (HIT-6, 67.2; SD, 4.4). Almost half of the participants had headache from overuse of medication (48%) and a family history of migraines (44%).

After 3 months, 87 percent of participants required an increase in the erenumab dose and 11 percent continued the 70 mg dose. By month 12, 4 percent stayed on the 70 mg dose, 94 percent received 140 mg, and 15 percent stopped erenumab therapy (ineffective treatment) [n=6], Pregnancy [n=1]Non-compliance [n=1]).

At the end of the study, the reduction in moderate to severe headache days was -10.8 (95% CI, -9.5 to -11.9; P <0.001) and the reduction in total monthly headache days was -13.0 (95% CI, -10.2 to -15.7; P <0.001). Most patients (85%) achieved a 50% reduction in moderate to severe headache days and 54% reported a 50% reduction in total headache days.

The reduction in headache severity was -1.3 (95% CI, -0.9 to -1.9; P <0.001) points. In addition, the days of analgesic use decreased by -4.3 after 12 months (95% CI, -1.6 to -6.9; P = 0.002). The disability due to headache was significantly reduced after 12 months (HIT-6, 59.7; SD, 8.6; P <0.001) compared to the baseline value (HIT-6, 67.4; SD, 4.4; P. <0.001).

Adverse events included constipation (16%), muscle spasms or spasms (11%), rash (5%), itching (5%), injection site pain (5%), thinning hair (4%), nasopharyngitis ( 2%)) and acne (2%). Disc edema occurred in 7 patients.

This study was limited by excluding the data from non-responders, which likely resulted in inflated results.

The study’s researchers concluded that their results “provide evidence of the effectiveness of erenumab in treating headache in IIH patients with papillary edema resolution. It provides mechanistic evidence suggesting that the peptide related to the calcitonin gene is likely a modulator causing headaches and is a useful therapeutic target. ”

Disclosure: Several authors have stated that they are part of the industry. For a full list of the details, see the original article.

reference

Yiangou A., Mitchell JL, Fisher C. et al. Erenumab for headache in idiopathic intracranial hypertension: a prospective open-label review. A headache. Published online on December 14, 2020 doi: 10.1111 / head.14026.

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